Krista L. Lentine, MD, MS, is an Assistant Professor of Medicine at Saint Louis University. She holds joint appointments in the Division of Nephrology and the Center for Outcomes Research, a division of Internal Medicine established to advance the university's clinical research efforts and infrastructure. Dr. Lentine has a strong interest in the epidemiology of cardiovascular disease among kidney transplant (KT) recipients. She is seeking a Mentored Clinical Scientist Development Award (K08) through the NIDDK to acquire the skills and mentored experience needed to become a leading independent investigator in transplant outcomes and policy. A unique feature of Dr. Lentine's career development plan is the merger of highly accomplished mentors across institutions, including the co-mentorship of Daniel C. Brennan, MD, Director of Transplant Nephrology at nearby Washington University, and Mark A. Schnitzler, PhD, Director of Transplant Outcomes and Policy Research at Saint Louis University. Dr. Lentine's program also draws upon the expertise of Kevin C. Abbott, MD, MPH, at Walter Reed in Washington, DC as an official collaborator. Doctoral studies in pursuit of a PhD in Health Outcomes Research at the Saint Louis University School of Public Health form the core of the proposal's Educational Plan. This program is designed to build upon Dr. Lentine's knowledge base recently acquired through a Master's degree program in Epidemiology at Stanford University. Formal courses ranging from ethics to advanced statistical analytical methods will be taken over the five years of the project, according to a curriculum integrated with the methodological needs of the Research Plan. The research agenda addresses the observation that traditional risk calculators do not accurately predict cardiovascular disease events among KT recipients. Dr. Lentine will explore the data repositories of the United States Renal Data System (USRDS), WellPoint - a large commerical health insurance provider, the Veterans Health Administration, and the Washington University KT Database for the broad goal of developing clinically useful, population-specific cardiovascular risk indices. The Specific Aims of the project are to: 1A) Construct an aggregate database of KT recipients by direct linkage of administrative and clinical records; 1B) Validate administrative data-based measures of cardiovascular outcomes compared to clinically derived indicators; 2) Describe the incidence of cardiovascular disease events among KT recipients; 3) Quantify the prognostic implications of cardiovascular events in this population; 4) Develop and validate clinical tools for predicting cardiovascular risk after kidney transplantation.